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6901 > Obesity > Flashcards

Obesity Flashcards

1
Q

what is better at predicting cardio-respiratory comorbidities than BMI

A

waist or collar circumference

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2
Q

BMI limitations

A
  • not a direct measure of adipose tissue or fat distribution

- inaccurate at height extremes of with lean body mass

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3
Q

ideal body weight

A

IBW (kg) = height in cm - x

x=100 for men, 105 for women

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4
Q

lean body weight

A

total body weight - adipose tissue

LBW=IBWx1.3

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5
Q

fat distribution patterns

A

apple/android: male, correlation with metabolic syndrome, increased morbidity and mortality

pear/gynoid: women, not correlated with metabolic syndrome

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6
Q

obesity BMI

A

> 30

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7
Q

morbidly obese BMI

A

> 40 or >35 with obesity-related comorbidity

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8
Q

obesity - cardiovascular changes

A
  • increase in CO (SV), blood volume, arrhythmias, workload on heart which leads to hypertrophy, HTN (blood viscosity, catecholamine and estrogen release)
  • hyperinsulinemia: increased levels of norepinephrine and angiotensinogen
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9
Q

total body water for obese patient

A

40%

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10
Q

obesity - coagulation changes

A
  • hypercoagulability, increased risk of DVT, CVA
  • adipose tissues promote chronic inflammatory state
  • increased clotting factors
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11
Q

obesity - respiratory changes

A
  • diaphragm cephalad
  • decreased: chest wall compliance, lung compliance, FRC, ERV, VC, TLC
  • increased: elastic resistance, work of breathing, pulmonary blood volume
  • unchanged: residual volume and closing capacity, FEV/FVC

*maintain normocapnia by increasing MV with rapid, shallow breathing

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12
Q

obstructive sleep apnea diagnosis criteria and 3 types

A

->10 seconds, >15 episodes per hour, >4% saturation decrease

  1. OSA: respiratory efforts without airflow
  2. central sleep apnea: no respiratory efforts
  3. mixed
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13
Q

STOP BANG - OSA criteria

A 
snoring
tiredness
observed stop breathing
blood pressure
BMI>35
age>50
neck circumference>40 cm
gender=male
  • high risk = more than 3
  • majority of patients are undiagnosed so it is important to screen
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14
Q

Pickwickian syndrome

A
  • obesity hypoventilation syndrome (OHS)
  • long term result of OSA
  • hypoventilation while awake with PaCO2>45 mmHg
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15
Q

obesity - gastric changes

A
  • increased: gastric pressure, GERD, volume, acidity, gallstones, pancreatitis
  • decreased: LES tone
  • delayed gastric emptying
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16
Q

obesity - hepatic changes

A
  • non-alcoholic fatty liver disease leads to cirrhosis: due to adipose tissue, impaired insulin activity, and inflammatory cytokines
  • elevated ALT
17
Q

obesity - endocrine changes

A
  • decreased insulin secretion, increased resistance

- hypothyroidism: thyroid hormone resistance in peripheral tissues, increased stimulation hormone levels

18
Q

metabolic syndrome

A
  • abdominal obesity: waist >102 cm in men, >88 in women
  • triglycerides: >150 mg/dL
  • HDL: <40 mg/dL in men, <50 in women
  • BP: >130/85
  • fasting glucose: >110 mg/dL

*need 3/5

19
Q

obesity - cancer changes

A

-3.2% of all new cancers are attributable to obesity

20
Q

obesity pharmacology - lipophilic drugs

A
  • increased volume of distribution, prolonged half life

- do not give much

21
Q

obesity pharmacology - hydrophilic drugs

A
  • volume of distribution unchanged

- dose for IBW

22
Q

obesity pharmacology - dose non-depolarizing muscle relaxants on ____

A

IBW

23
Q

obesity pharmacology - dose succinylcholine on ____

A

TBW - due to increased pseudocholinesterase activity

24
Q

obesity pharmacology - dose Propofol induction on ____, maintenance on ____

A

LBW

TBW, and decrease with time to avoid accumulation

25
Q

obesity pharmacology - dose opioids

A

initial doses are the same, repeat doses are less predictable

26
Q

categories of bariatric surgery

A
  • gastric restrictive

- restrictive and nutrient malabsorptive

27
Q

s/s of anastomotic leak

A
  • unexplained tachycardia
  • fever
  • abdominal pain
  • shoulder pain
  • SOB
  • hypotension
  • hiccups
  • restlessness
28
Q

Obesity Surgery-Mortality Risk Score

A
  • BMI>50
  • male
  • HTN
  • high risk DVT
  • age>45

0-1: low
2-3: intermediate
4-5: high

29
Q

obesity - estimated blood volume

A

45-55 mL/kg

6901 (18 decks)

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